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Varus malalignment of short femoral stem not associated with post-hip arthroplasty fracture

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Periprosthetic femoral fractures are an increasingly common post-operative complication of total hip arthroplasty (THA). Though varus malalignment is known to increase fracture risk in standard-length femoral stems, varus malalignment is not as well studied in short stems. Therefore, the purpose of this study was to determine if varus malalignment contributes to early periprosthetic fracture risk in a cementless taper-wedged, short femoral stem.

Materials and methods

This retrospective review included 366 consecutive patients (441 THAs) having undergone THA via anterior approach by a single surgeon between July 2014 and December 2016. All patients received the same short, cementless femoral stem. Femoral component angle was measured on 6-week post-THA weight-bearing radiographs, with malalignment defined as a femoral component angle exceeding 0° ± 3°. Periprosthetic femoral fracture and aseptic loosening occurring within 2 years post-THA were recorded.

Results

The final data analysis included 426 hips with a mean follow-up time of 32.9 ± 10.2 months. Varus and neutral alignment occurred in 84 (19.6%) and 342 (79.9%) of stems, respectively. Three (0.7%) periprosthetic femoral fractures occurred within 2 years, all occurring in patients with neutrally aligned femoral stems. One (0.2%) stem failed due to aseptic loosening and was malaligned.

Conclusion

Despite nearly 20% of stems placed in varus alignment, three of the four early complications occurred in a neutrally aligned stem. Based on these results, forceful intraoperative realignment of a short femoral stem with good initial fixation may present an unnecessary increased risk of intraoperative fracture.

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Funding

This research received no specific grant from any funding agency in the public, commercial or non-for-profit sectors.

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Authors and Affiliations

  1. Bone & Joint Center, Straub Medical Center, 888 South King Street, Honolulu, HI, 96818, USA

    Scott T. Nishioka, Samantha N. Andrews, Kristin Mathews & Cass K. Nakasone

  2. Department of Surgery, University of Hawai’i, John A. Burns School of Medicine, 1356 Lusitana Street, Honolulu, HI, 96813, USA

    Samantha N. Andrews & Cass K. Nakasone

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  1. Scott T. Nishioka
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Correspondence to Samantha N. Andrews.

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This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Hawai‘i Pacific Health Research Institute (local Western Institutional Review Board) approved this study.

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Nishioka, S.T., Andrews, S.N., Mathews, K. et al. Varus malalignment of short femoral stem not associated with post-hip arthroplasty fracture. Arch Orthop Trauma Surg 142, 3533–3538 (2022). https://doi.org/10.1007/s00402-021-04244-w

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